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APPLICATION FORM FOR TEACHING POST (To be filled by the candidate)
Please affix your latest passport size self attested photograph
[Part-1]
Name & Address of Issuing Bank Draft Number Date Amount
Post Applied for : Advertisement No. S. No of Post Closing date for receipt of application
1. Name in full (in capital letters) First name-Middle name-Surname 2. Date of birth (DD, MM, YY) and Sex 3. Age as on closing date 4. Fathers name 5. Designation of the candidate (if employed) 6. Name of the Institution/ Organization where employed. 7. Actual place of posting 8. (a) Full postal address for correspondence with pin code; 8. (b) Telephone No., e-mail ID and Mobile no.
Day Day
Month Month
Year Year
Sex
Male
Female
10. Are you a citizen of India? If so, whether by birth/domicile. 11. *Category (Write SC/ST/ OBC/ General and Name of State)/ Sub Category
12. Have you ever been convicted by a court of law for any offence? If so, details thereof. 13. Have you ever been punished or debarred from service of Government, other organization. If so, details thereof. 14. Indicate if you possess essential Qualification if yes fill the full detail 15. If selected, are you prepared to accept the minimum initial pay offered? If not, state the lowest initial pay that you would accept in the prescribed scale. Signature of the Candidate : Date and Place :
Essential :
[Part-2]
A. Academic Qualifications Exam/Degree/ Institute/Board/University Diploma High School Intermediate Graduation Masters Ph. D. Post-Doctorate Other Please enclose attested copies of certificate/ Degree with the application form. B. Administrative/ Research Management Positions (RMP) / Project Management and In-charge. Nature of Work Duration From To
Year
Class/Division/ Grade/%marks
Remarks
Year
C. Employment Record & Experience (appointment letter & Experience certificate enclosed) Designation Pay scale Nature of work Organization/ Institution & Place of posting From
Period To
D. Experience in relevant field Experience in the field of preferential qualifications including SRF/JRF/PDF etc. Name of relevant Field Duration From To
Year
E. In-service Award/Recognition / Fellowship Name of the Awarding Organization (place / Award/Recognition / country) Fellowship
Year
F. Special Attainments (Technology development, Variety released, Patent, Prototype, Concept, Methodology, highlight any salient research/success story) Category Title Year Details
Year From
Duration To
Duration
Year
As PI/Co-PI
Amount
Country visited
Year From
Duration To
D:\Website\Website Backup 22.04.2013\Index 01.5.2013\Advertiesment\Final Add 2013\Application for Teaching\Engliah form 2013.docx
J. Any other relevant information not covered above (NCC/NSS/Sports etc.) Attach certificate S.No. Item Duration Details
K. Publications 1. Research paper in international journals * 2. Research paper in national journals* 3. Review article in referred journals/Research paper in Univ. journal/Lead paper 4. Books/Manuals (published by publishers) 5. Manuals (Institute level) 6. Chapter in book 7. *Popular articles in magazine/research paper in non referred journals
Abstract in published proceedings/souvenir will be considered as equivalent to popular article.
*Submit the list of research paper in following format: Author Year Title Journal with Vol., Nos. Page(s) Thomson Reauters rating if any
DECLARATION a) I hereby declare that the entries in this application are true to the best of my knowledge/ belief and also that I have not concealed any fact or with held any information regarding my past services and record and that if any entry is found to be false or incorrect or that if at any time this is found to have been concealed, I will be disqualified for selection or if appointed will be liable to termination without any notice or compensation. I certify that I have read the employment notice carefully.
b)
Candidates signature
D:\Website\Website Backup 22.04.2013\Index 01.5.2013\Advertiesment\Final Add 2013\Application for Teaching\Engliah form 2013.docx